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Levinstein Y, Zerach G, Levi-Belz Y, Bonanno GA. Trajectories of moral injury and their associations with posttraumatic stress symptoms among recently discharged israeli veterans. J Psychiatr Res 2024; 177:321-329. [PMID: 39067256 DOI: 10.1016/j.jpsychires.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/15/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND While it is already known that potentially morally injurious events (PMIEs) have a deleterious effect on veterans, little is known about the changes in PMIEs subjective appraisals over time, as well as its contribution to changes in psychiatric symptoms. In the current study, we longitudinally assessed subjective appraisals of PMIEs experienced during combat military service and their associations with posttraumatic stress symptoms (PTSS) among recently discharged combat veterans. METHOD Participants were 374 veterans who participated in a one-year longitudinal study with three measurement points: T1-one month before discharge from army service, and then again six months and twelve months following discharge (T2 and T3, respectively). RESULTS Latent Growth Mixture Modeling (LGMM) indicated heterogenic patterns of changes in PMIEs across measurements. The 'resilient' (low and stable PMIEs) trajectory best represented PMIE, followed by 'recovery' and 'chronic' fluctuating trajectories. Moreover, the 'resilient' PMIEs trajectory was found to be consistently associated with lower PTSS scores compared to 'chronic' or 'worsening' trajectories. CONCLUSIONS Our findings are the first to identify longitudinal trajectories of PMIEs subjective appraisals and to provide evidence of their association with PTSS, which might serve as potential assessment and intervention targets among recently discharged traumatized veterans.
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Affiliation(s)
- Yoav Levinstein
- Dept. of Health and Well-being, Medical Corps, IDF, School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
| | - Gadi Zerach
- Dept. of Psychology, Ariel University, Ariel, Israel
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - George A Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
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Van Wijk CH. Prevalence Estimate for Adjustment Disorders in the South African Navy. Clin Pract Epidemiol Ment Health 2024; 20:e17450179301661. [PMID: 39135946 PMCID: PMC11318156 DOI: 10.2174/0117450179301661240528064329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 08/15/2024]
Abstract
Introduction and Aim Adjustment Disorder is among the most commonly diagnosed mental disorders in the armed forces, with a mean prevalence estimated at 7.4% across military populations. The prevalence in South African military populations is not known. This study aimed to estimate the prevalence of Adjustment Disorders in the South African Navy and to explore potential risk factors. Methods In this cross-sectional study, a representative sample of 714 sailors completed the International Adjustment Disorder Questionnaire, and also provided information from their biennial occupational health assessment mental health screening, which included other clinical screeners of mental health and adjustment history. Results The estimated prevalence of Adjustment Disorders in the South African Navy was 6.9%, and was proportionally distributed across gender and age categories. Depression and PTSD were the main comorbid conditions. Risk factors included a) history of adjustment difficulties during military deployment or family adjustment difficulties, b) domestic discord (difficulties in relationship with spouse/partner or immediate family), and c) the experience of stress overload (i.e., that the demands of life are overwhelming available resources). Conclusion The estimated prevalence was similar to the expectation of military personnel generally, although the self-report data needs to be interpreted cautiously. The contributing risk factors offer possible direction for targeted intervention, e.g., skills training and relationship counselling to enhance coping with military service and family challenges, and cognitive behaviour therapy generally to address sailors' experience of stress overload.
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Affiliation(s)
- Charles H. Van Wijk
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Wesemann U, Renner KH, Rowlands K, Köhler K, Hüttermann N, Himmerich H. Incidence of mental disorders in soldiers deployed to Afghanistan who have or have not experienced a life-threatening military incident-a quasi-experimental cohort study. Front Public Health 2024; 12:1357836. [PMID: 38584933 PMCID: PMC10995976 DOI: 10.3389/fpubh.2024.1357836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/09/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction There is very good international research on deployment-related mental disorders in military personnel. The incidence rates show a very wide range. A new strategy is therefore proposed in order to achieve better standardization and thus better comparability of the studies. In addition to a non-deployed comparison group, we propose to compare deployed soldiers with and without critical military incidents during the deployment. This additional distinction makes it possible to differentiate between the influencing variables of actual threat and general deployment stress. Methods N = 358 male combat soldiers deployed to Afghanistan were included in the study. Clinical interviews were conducted several days before deployment and after deployment. Of them, n = 80 soldiers suffered a life-threatening military incident during deployment, whereas 278 soldiers did not. Odds ratios (OR) were calculated for the groups with and without critical military incidents and the new onset for PTSD, anxiety disorders and depressive disorders. Results When comparing both groups, we found significantly higher 1-year incidence rates in the group with critical military incidents: 6.4% vs. 1.1% (OR 6.2) for post-traumatic stress disorder (PTSD); 7.0% vs. 1.1% (OR 6.5) for depression; and 15.9% vs. 2.8% (OR 6.6) for anxiety disorders. The 1-year incidence rate of mental multimorbidity (PTSD with anxiety or depression) was 4.8% vs. 0.4% (OR 12.0). Discussion These results indicate that life-threatening military incidents during military deployment are important to mental health. As the different threat levels of the various missions are taken into account, additional predictors could be determined more precisely in further research.
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Affiliation(s)
- Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Karl-Heinz Renner
- Faculty of Human Sciences, Institute of Psychology, Bundeswehr University Munich, Neubiberg, Germany
| | - Katie Rowlands
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Kai Köhler
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Nils Hüttermann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Hubertus Himmerich
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
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Stoltenberg CDG, Vedtofte MS, Nielsen ABS, Andersen SB, Siersma V, Christensen KS, Osler M. Mental healthcare utilisation among Danish formerly deployed military personnel and their civilian counterparts: a cohort study. Eur J Psychotraumatol 2024; 15:2296188. [PMID: 38227366 PMCID: PMC10795587 DOI: 10.1080/20008066.2023.2296188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024] Open
Abstract
Background: Prior studies comparing the mental healthcare utilisation (MHU) of Danish formerly deployed military personnel (FDP) with the general population have not included data on psychotherapy through the Defence or talking therapy with the general practitioner. This study included these and several other data sources in a comprehensive comparison of MHU between Danish FDP and civilians.Methods: First-time deployed military personnel (N = 10,971) who had returned from a mission to Kosovo, Afghanistan, Iraq or Lebanon between January 2005 and July 2017 were included. A sex and birth-year-matched civilian reference group was randomly drawn from the entire Danish non-deployed population (N = 253,714). Furthermore, a sub-cohort, including male FDP and civilians deemed eligible for military service, was defined. These cohorts were followed up in military medical records and registers covering the primary and secondary civilian health sectors from 2005 to 2018, and the rates of MHU were compared.Results: Approximately half of the initial help-seeking for FDP took place through the Defence (49.4%), and the remainder through the civilian healthcare system. When help-seeking through the Defence was not included, MHU was significantly lower among FDP in the main cohort during the first two years (IRR = 0.84, 95% CI: [0.77, 0.92]) compared to civilians. When help-seeking through the Defence was included, MHU was significantly higher among FDP compared to civilians both in the first two years of follow-up (IRR = 2.01, 95% CI: [1.89, 2.13]) and thereafter (IRR = 1.18, 95% CI: [1.13, 1.23]). In the sub-cohort, these differences were even more pronounced both in the first two years of follow-up and thereafter.Conclusions: MHU was higher among Danish FDP compared to civilians only when data from the Defence was included. The inclusion of data on both civilian and military healthcare services is necessary to evaluate the full impact of deployment on MHU among Danish FDP.
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Affiliation(s)
- Christian Ditlev Gabriel Stoltenberg
- Research and Knowledge Centre, The Danish Veterans Centre, Ringsted, Denmark
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Sadowa Vedtofte
- Research and Knowledge Centre, The Danish Veterans Centre, Ringsted, Denmark
| | - Anni Brit Sternhagen Nielsen
- Research and Knowledge Centre, The Danish Veterans Centre, Ringsted, Denmark
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren Bo Andersen
- Research and Knowledge Centre, The Danish Veterans Centre, Ringsted, Denmark
| | - Volkert Siersma
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kaj Sparle Christensen
- The Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Merete Osler
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
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Morgan MA, O'Gallagher K, Kelber MS, Garvey Wilson AL, Evatt DP. Diagnostic and functional outcomes of adjustment disorder in U.S. active duty service members. J Affect Disord 2023; 323:185-192. [PMID: 36455712 DOI: 10.1016/j.jad.2022.11.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adjustment disorder (AD) is a commonly diagnosed psychiatric disorder. However, little is known about its course, predictors of its diagnostic outcomes, or its association with functional impairment. Our primary aim was to examine diagnostic transitions of service members with an incident AD diagnosis (IADx) to one of three states: 1) another psychiatric diagnosis, 2) chronic AD, or 3) no psychiatric diagnosis. Secondary outcomes included predictors of diagnostic course and functional outcomes associated with follow-up diagnoses. METHODS Health records of a random sample of 10,720 service members with an IADx were analyzed using multinomial logit regression and hazard rate model with competing risks. RESULTS IADx transitions were 24.3 % to another psychiatric diagnosis, 8.9 % with chronic AD, and 43.7 % without a diagnosis. Nearly a quarter (23.1 %) separated from service. Deployment was the strongest predictor of transitioning to another diagnosis. Those who transitioned to another diagnosis separated at an increased rate and with more adverse outcomes. LIMITATIONS Diagnostic findings are based on data in the electronic health record, and we could not specifically identify the stressor that precipitated an AD diagnosis. These findings describe the course of AD in military personnel and may not generalize to civilians. CONCLUSIONS AD, as initially diagnosed, represents a heterogeneous disorder with an enduring impact across the military career for a considerable proportion of service members. As an early indicator of more severe psychiatric outcomes, an IADx may signal an opportunity for early intervention and screening, particularly in service members with a history of deployment.
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Affiliation(s)
- Maria A Morgan
- Psychological Health Center of Excellence (PHCoE), Defense Health Agency, USA.
| | - Kevin O'Gallagher
- Psychological Health Center of Excellence (PHCoE), Defense Health Agency, USA
| | | | | | - Daniel P Evatt
- Psychological Health Center of Excellence (PHCoE), Defense Health Agency, USA
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Adjustment Disorder in U.S. Service Members: Factors Associated With Early Separation. Mil Med 2022. [DOI: 10.1093/milmed/usac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Introduction
Adjustment disorder (AD) is a time-delimited disorder characterized by excessive emotional distress or impaired functioning in response to an identifiable stressor. Although it is commonly diagnosed in mental health settings, its impact on occupational, social and other areas of functioning is not well understood. As a subthreshold disorder that is frequently diagnosed in conjunction with other physical and mental health disorders, the extent of its contribution to functional impairment may be obscured. During military service, research suggests AD is frequently diagnosed in early-service trainees. To help elucidate the relationship between AD and functional outcome, we explored 2 factors that may be associated with the rate of separation from service in U.S. active duty service members (SMs) with an AD diagnosis: previous mental health diagnoses and time in service when SMs receive an incident AD diagnosis (IADx).
Materials and Methods
Twenty-thousand SMs with an IADx were grouped by whether or not this was their first mental health diagnosis received in the military. To assess functional impairment, the 2 groups were compared on rate of separation. Those without prior diagnoses were then stratified into 5 groups based on length of time from military entrance to receipt of IADx and were further analyzed for separation rates. The Cox model was used to determine hazard ratios and create survival curves. The study was determined to be “not human subjects research.”
Results
Nearly half (46.4%) of SMs with an IADx previously had received a mental health diagnosis and had an increased risk of separation [hazard ratio = 1.25 (95% confidence interval: 1.207-1.286)]. Of SMs with IADx as their first diagnosis, 19.3% were diagnosed during the first 6 months of service and had the highest risk of separating [hazard ratio = 1.48 (1.381-1.589)], with a 60% probability of separating within 2 years of diagnosis. Those receiving it during the second 6 months of service (16.2%), second year (20.1%), or third year (18.2%) had approximately a 47% probability of separating within 2 years.
Conclusions
Previous mental health diagnoses and time in service when diagnosed appear to be important factors associated with functional impairment for SMs with AD. Nearly half of those with an IADx had previously received diagnoses for mood, anxiety, and other disorders and were at higher risk of separation following IADx. Our findings are based on diagnoses entered in electronic health records, so we cannot identify the nature of the stressor that precipitated AD. Nonetheless, early IADx predicted the fastest rate of separation, and it may be an opportune time for interventions to reduce its impact on functional outcomes.
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Moore BA, Straud CL, Hale WJ, Baker MT, Gardner CL, Judkins JL, Shinn AM, Savell SW, Cigrang JA, Mintz J, Rouska A, McMahon C, Lara-Ruiz JM, Young-Mccaughan S, Peterson AL. Post-9/11 service members: Associations between gender, marital status, and psychiatric aeromedical evacuations from combat zones. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1962192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Brian A. Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Psychology, University of Texas, San Antonio, Texas, USA
- Office of Research and Development, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Willie J. Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Psychology, University of Texas, San Antonio, Texas, USA
| | - Monty T. Baker
- Wilford Hall Ambulatory Surgical Center, San Antonio, Texas, USA
| | - Cubby L. Gardner
- Wilford Hall Ambulatory Surgical Center, San Antonio, Texas, USA
| | - Jason L. Judkins
- United States Army Institute of Environmental Medicine, Natick, Massachusetts, USA
| | | | | | - Jeffery A. Cigrang
- School of Professional Psychology, Wright State University, Dayton, Ohio, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
- Office of Research and Development, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Ashton Rouska
- Uniformed Services University of the Health Sciences, Naval Support Activity Bethesda, Bethesda, Maryland, USA
| | - Chelsea McMahon
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Psychology, University of Texas, San Antonio, Texas, USA
| | - Jose M. Lara-Ruiz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Stacey Young-Mccaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
- Office of Research and Development, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Psychology, University of Texas, San Antonio, Texas, USA
- Office of Research and Development, South Texas Veterans Health Care System, San Antonio, Texas, USA
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Janssen DGA, Vermetten E, Egberts TCG, Heerdink ER. Discontinuation Rates of Antidepressant Use by Dutch Soldiers. Mil Med 2019; 184:868-874. [PMID: 31004149 DOI: 10.1093/milmed/usz060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/21/2019] [Accepted: 03/12/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Soldiers have a higher risk for developing psychiatric disorders that require treatment; often with antidepressants. However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways. In the general population, early discontinuation of antidepressant treatment is often seen. It is yet unknown whether this occurs to a similar extent in soldiers. The objective of this study was to evaluate discontinuation of antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof. MATERIALS AND METHODS Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressant between 2000 and 2014 were included. Kaplan-Meier curves were constructed to estimate the discontinuation rate over time and the influence of each determinant on discontinuation rate was estimated using Cox regression. RESULTS About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months this number increased to 52.7% and 70.3%, respectively. Early discontinuation was higher in soldiers who received their first prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55-2.21, HR 2.66 95% CI 1.97-3.58) compared to soldiers with a first prescription from a general practitioner. In addition, early discontinuation was lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI 0.51-0.60, HR 0.63, 95% CI 0.55-0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70-0.89). CONCLUSION More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6 months, only 30% were still on antidepressants.
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Affiliation(s)
- Debbie G A Janssen
- Expert Centre of Military Pharmacy, Primary Healthcare Institute, Ministry of Defence, PO Box 90004 3509 AA Utrecht, The Netherlands
| | - Eric Vermetten
- Rudolf Magnus Institute of Neurosciences and Department of Military Psychiatry, Central Military Hospital, Ministry of Defence, PO Box 90000 3509 AA Utrecht, The Netherlands.,Department of Psychiatry, Leiden University Medical Centre, PO Box 9600 2300 RC Leiden, The Netherlands.,ARQ Psychotrauma Expert Group, Nienoord 5 1112 XE Diemen, The Netherlands
| | - Toine C G Egberts
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, PO Box 80082 3508 TB Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, PO Box 85500 3508 GA Utrecht, The Netherlands
| | - Eibert R Heerdink
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, PO Box 80082 3508 TB Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, PO Box 85500 3508 GA Utrecht, The Netherlands.,Research Group Process Innovations in Pharmaceutical Care, HU University of Applied Sciences Utrecht, PO Box 12011 3501 AA Utrecht, The Netherlands
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de Kruijff LGM, Moussault ORM, Plat MCJ, Hoencamp R, van der Wurff P. Coping strategies of Dutch servicemembers after deployment. Mil Med Res 2019; 6:9. [PMID: 30929640 PMCID: PMC6442403 DOI: 10.1186/s40779-019-0199-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/25/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study examines the relationship between coping strategies and symptoms of anxiety or depression among Dutch servicemembers deployed to Afghanistan. METHODS Coping strategies were assessed in 33 battlefield casualties (BCs) and the control group (CTRLs) of 33 uninjured servicemembers from the same combat units using the Cognitive Emotion Regulation Questionnaire. A factor analysis was performed, and two clusters of coping strategies were derived, namely, adaptive and maladaptive coping. Symptoms of anxiety and depression were evaluated using the depression and anxiety subscales of the Symptom Checklist-90-Revised. Correlations between coping and symptoms of anxiety and between coping and symptoms of depression were calculated, and a logistic regression was performed. RESULTS A moderate correlation was observed between maladaptive coping and symptoms of anxiety in the BC group (r = 0.42) and among the CTRLs (r = 0.56). A moderate correlation was observed between maladaptive coping and symptoms of depression in both groups (r = 0.55). The statistical analysis for the total sample (BCs and CTRLs) demonstrated no association between coping and symptoms of anxiety or depression. CONCLUSIONS A correlation but no association was observed between maladaptive coping and mental health disorders in deployed Dutch servicemembers. Further research should focus on constructing cluster profiles of coping strategies and associating them with mental health outcomes and reintegration into society.
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Affiliation(s)
- Loes G M de Kruijff
- Department of Research and Development, Military Rehabilitation Center Aardenburg, Doorn, 3941, PW, The Netherlands. .,De Hoogstraat Rehabilitation, Utrecht, 3583, TM, The Netherlands. .,Department of Research and Development, Military Rehabilitation Center Aardenburg, P.O. box 185, Doorn, 3940, AD, The Netherlands.
| | - Olivia R M Moussault
- Military Mental Healthcare, Ministry of Defense, Zwolle, 8022, AE, The Netherlands
| | - Marie-Christine J Plat
- Force Health Protection, Expert Center Force Health Protection, Ministry of Defense, Doorn, 3941, PW, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Leiden University Medical Center, 2333, ZA, Leiden, The Netherlands.,Department of Surgery, Alrijne Medical Center, Leiderdorp, 2334, CK, The Netherlands.,Department of Surgery, Central Military Hospital Ministry of Defense, Utrecht, 3584, EZ, The Netherlands
| | - Peter van der Wurff
- Department of Research and Development, Military Rehabilitation Center Aardenburg, Doorn, 3941, PW, The Netherlands.,Institute of Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, 3584, CS, The Netherlands
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10
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Phinney B, Zamorski M, Fikretoglu D. Comparison of past-year mental health services use in Canadian Army, Navy, and Air Force personnel. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2017-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: What causes the excess burden of mental disorders and related outcomes in the Army remains unclear. Deployment-related trauma has been one intuitive explanation. However, there may be other factors at play – for example, lower mental health services use (MHSU) in Army personnel. This study compares MHSU across the Canadian Army, Navy, and Air Force. Methods: Data were drawn from the 2013 Canadian Forces Mental Health Survey. The sample consisted of Regular Force members ( N = 6,696). The primary outcomes for past-year MHSU were: (1) any past-year MHSU; (2) intensity of care (total clinical contact hours), and (3) perceived helpfulness of care (PHC). Modified Poisson regression and analysis of covariance (ANCOVA) were used to assess the relationship between the elements (Army, Navy, Air Force) and each outcome, adjusting for sociodemographic and military characteristics, as well as clinical variables such as the presence of five past-year mental disorders. Results: In unadjusted analyses, Army personnel had significantly greater past-year MHSU and intensity of care relative to Air Force personnel. No significant relationship was found between the element and any of the MHSU parameters after adjustment. Discussion: Differences in past-year MHSU are an unlikely contributing factor to the higher risk of mental disorders and related outcomes among Army personnel; the true explanation must lie elsewhere. Findings argue for a system-wide, and not element-specific, approach to improving Canadian Armed Forces (CAF) programs and services.
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Affiliation(s)
- Brigitte Phinney
- Canadian Forces Health Services Group, Directorate of Mental Health, Ottawa, Ontario, Canada
| | - Mark Zamorski
- Canadian Forces Health Services Group, Directorate of Mental Health, Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Human Performance and Resilience Group, Defence Research and Development Canada Toronto Research Centre, Toronto, Ontario, Canada
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Vermetten E, Ambaum J. Exposure to combat and deployment; reviewing the military context in The Netherlands. Int Rev Psychiatry 2019; 31:49-59. [PMID: 31184276 DOI: 10.1080/09540261.2019.1602517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper reviews the military context of exposure to combat and deployment in Dutch soldiers. It does so by reviewing war victims and military psychiatry after WWII in the Netherlands, and describes Dutch deployments from the late 1970s to the present. 'Who is the Dutch soldier' is asked to articulate the mental load on the individual soldier before, during, and after deployment. The narrative review of this paper allows one to review how the armed forces personnel is challenged in relation to their specific assignment and in what respect the psychological dimensions are addressed and met in the face of risk and adversity. Finally, some critical considerations for future veterans care programmes are raised.
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Affiliation(s)
- Eric Vermetten
- a Military Mental Health - Research Center , Utrecht , The Netherlands.,b Department of Psychiatry , Leiden University Medical Center , Leiden , The Netherlands.,c Arq Psychotrauma Expert Group , Diemen , The Netherlands
| | - Jan Ambaum
- b Department of Psychiatry , Leiden University Medical Center , Leiden , The Netherlands
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12
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Karstoft KI, Andersen SB, Nielsen ABS. Assessing PTSD in the military: Validation of a scale distributed to Danish soldiers after deployment since 1998. Scand J Psychol 2017; 58:260-268. [PMID: 28419465 DOI: 10.1111/sjop.12360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
Abstract
Since 1998, soldiers deployed to war zones with the Danish Defense (≈31,000) have been invited to fill out a questionnaire on post-mission reactions. This provides a unique data source for studying the psychological toll of war. Here, we validate a measure of PTSD-symptoms from the questionnaire. Soldiers from two cohorts deployed to Afghanistan with the International Security Assistance Force (ISAF) in 2009 (ISAF7, N = 334) and 2013 (ISAF15, N = 278) filled out a standard questionnaire (Psychological Reactions following International Missions, PRIM) concerning a range of post-deployment reactions including symptoms of PTSD (PRIM-PTSD). They also filled out a validated measure of PTSD-symptoms in DSM-IV, the PTSD-checklist (PCL). We tested reliability of PRIM-PTSD by estimating Cronbach's alpha, and tested validity by correlating items, clusters, and overall scale with corresponding items in the PCL. Furthermore, we conducted two confirmatory factor analytic models to test the factor structure of PRIM-PTSD, and tested measurement invariance of the selected model. Finally, we established a screening and a clinical cutoff score by application of ROC analysis. We found high internal consistency of the PRIM-PTSD (Cronbach's alpha = 0.88; both cohorts), strong item-item (0.48-0.83), item-cluster (0.43-0.72), cluster-cluster (0.71-0.82) and full-scale (0.86-0.88) correlations between PRIM-PTSD and PCL. The factor analyses showed adequate fit of a one-factor model, which was also found to display strong measurement invariance across cohorts. ROC curve analysis established cutoff scores for screening (sensitivity = 1, specificity = 0.93) and clinical use (sensitivity = 0.71, specificity = 0.98). In conclusion, we find that PRIM-PTSD is a valid measure for assessing PTSD-symptoms in Danish soldiers following deployment.
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Affiliation(s)
| | - Søren B Andersen
- Research and Knowledge Centre, the Danish Veteran Centre, Ringsted, Denmark
| | - Anni B S Nielsen
- Research and Knowledge Centre, the Danish Veteran Centre, Ringsted, Denmark.,The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Denmark
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13
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Prevalence of use of erectile dysfunction medication by Dutch military personnel between 2003 and 2012. Int J Impot Res 2016; 29:54-56. [PMID: 27853169 DOI: 10.1038/ijir.2016.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/09/2016] [Accepted: 10/03/2016] [Indexed: 11/08/2022]
Abstract
Use of ED medication can be seen as a marker for ED. ED is associated with increasing age, exposure to traumatic events and physical injuries in military veterans. The objective of this study was to assess the prevalence of use of ED medication in Dutch military personnel in the period 2003-2012 and to assess its association with age and psychotropic medication use. Data on dispensing of ED medication, age and co-medication with psychotropic medication of all Dutch military personnel between 2003 and 2012 were collected. The prevalence of ED medication use in each year was estimated, stratified for age and use of psychotropic medication. The number of ED medication users increased a hundredfold from 0.09 to 9.29 per 1000 per year between 2003 and 2012. ED medication was more often used by men over 40 than under 40 (prevalence in 2012: 2.4% vs 0.2%, OR (2003-2012, adjusted for calendar year) 15.6, 95% CI 13.5-17.9) and by men using psychotropic medication (prevalence in 2012: 3.8% vs 0.9%, OR (2003-2012, adjusted for calendar year) 3.13, 95% CI 2.66-3.67). This study shows a strong increase between 2003 and 2012 in a number of ED medication users in male Dutch military personnel. ED medication use increases with age and with psychotropic medication use.
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14
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The long-term burden of military deployment on the health care system. J Psychiatr Res 2016; 79:78-85. [PMID: 27214524 DOI: 10.1016/j.jpsychires.2016.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/29/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022]
Abstract
Health care providers need to be aware that stress complaints that result from deployment can emerge even after many years. This has important implications for health care policies. The main aim of this study is to investigate the relation between the development of posttraumatic stress and other mental health complaints and the burden on (mental) health care after a deployment. For this study we used data from a large prospective cohort study on stress-factors related to deployment in 1007 Dutch soldiers, who were deployed to Afghanistan. Participants were assessed at six follow up times up until five years after deployment. In a Generalized Estimated Equations model we estimated the relation between mental health complaints and the utilization of psychological treatment and a general practitioner, respectively. Moreover, we studied the relation between mental health complaints and health care costs using bootstrap techniques. The results showed that higher scores for PTSD, depression and fatigue relate to increased use of a psychologist. And lower PTSD scores and higher depression, anxiety and somatization scores relate to increased odds to visit a GP. Furthermore, mental health complaints relate to higher costs. In conclusion, monitoring soldiers is important in order to be informed on the current demand for (mental) health care to satisfy the health care need of veterans. Early treatment, which is enabled by lowering barriers to care, relates to positive results and therefore, lower health care costs.
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Averill LA, Eubanks Fleming CJ, Holens PL, Larsen SE. Research on PTSD prevalence in OEF/OIF Veterans: expanding investigation of demographic variables. Eur J Psychotraumatol 2015; 6:27322. [PMID: 25971312 PMCID: PMC4430556 DOI: 10.3402/ejpt.v6.27322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD) screenings within the Operation Enduring Freedom (Afghanistan conflict)/Operation Iraqi Freedom (Iraq conflict) (OEF/OIF) military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination. OBJECTIVE Many OEF/OIF Veterans do not use available Veterans Affairs (VA) services, especially mental health care. This highlights the need to understand the differences between those who use and do not use the VA, especially as research with pre-OEF/OIF Veterans suggests that these two groups differ in significant ways. The high rates of PTSD-related concerns in non-VA users also points to a need to understand whether-and where-Veterans are seeking care outside the VA and the accessibility of evidence-based, trauma-focused treatments in the community and private sectors. Careful examination of relationship status is also paramount as little research has examined relationship status or other relationship context issues. Social support, especially from a spouse, can buffer the development of PTSD; however, relationship discord has the potential to greatly exacerbate PTSD symptomatology. Furthermore, given the additional risk factors for sexual minority Veterans to be exposed to trauma, the 2011 repeal of the US Military "Don't Ask, Don't Tell" policy, and the emergence of the VA as likely the largest health care provider for sexual minority Veterans, it will be critically important to study the trauma and mental health experiences of this group. CONCLUSIONS Studies that examine prevalence rates of PTSD in the returning cohort contribute significantly to our understanding of the US OEF/OIF military population. Further study of PTSD in relation to demographic variables such as VA and non-VA use, relationship status, and sexual orientation will provide rich data that will enhance our ability to develop policy and practice to provide the best care to this population.
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Affiliation(s)
- Lynnette A Averill
- Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA;
| | - C J Eubanks Fleming
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Pamela L Holens
- Department of Clinical Health Psychology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Operational Stress Injury Clinic, Deer Lodge Centre, Winnipeg, MB, Canada
| | - Sadie E Larsen
- Psychology Service, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Hoencamp R, Idenburg FJ, van Dongen TTCF, de Kruijff LGM, Huizinga EP, Plat MCJ, Hoencamp E, Leenen LPH, Hamming JF, Vermetten E. Long-term impact of battle injuries; five-year follow-up of injured Dutch servicemen in Afghanistan 2006-2010. PLoS One 2015; 10:e0115119. [PMID: 25643003 PMCID: PMC4313947 DOI: 10.1371/journal.pone.0115119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022] Open
Abstract
Objectives Units deployed to armed conflicts are at high risk for exposure to combat events. Many battle casualties (BCs) have been reported in the recent deployment to Afghanistan. The long-term impact of these combat injuries, at their five-year end point, is currently unknown. To date, no systematic inventory has been performed of an identified group of BCs in comparison to non-injured service members from the same operational theatre. Design Observational cross-sectional cohort study. Setting Open online survey among Dutch BCs that deployed to Afghanistan (2006–2010). Participants The Dutch BCs (n = 62) were compared to two control groups of non-injured combat groups (battle exposed [n = 53], and non-battle exposed [n = 73]). Main Outcome Measures Participants rated their impact of trauma exposure (Impact of Events [IES]), post deployment reintegration (Post Deployment Reintegration Scale [PDRS]), general symptoms of distress (Symptom Checklist 90 [SCL-90]), as well as their current perceived quality of life (EuroQol-6D [EQ-6D]). Also cost effectiveness (Short From health survey [SF-36]) and care consumption were assessed (Trimbos/iMTA questionnaire). Results Over 90% of BCs were still in active duty. The mean scores of all questionnaires (IES, EQ-6D, SF-36, and SCL-90) of the BC group were significantly higher than in the control groups (p<0.05). The PDRS showed a significantly lower (p<0.05) outcome in the negative subscales. The mean consumption of care was triple that of both control groups. A lower score on quality of life was related to higher levels of distress and impact of trauma exposure. Conclusions This study showed a clear long-term impact on a wide range of scales that contributes to a reduced quality of life in a group of BCs. Low perceived cost effectiveness matched with high consumption of care in the BC group in comparison to the control groups. These results warrant continuous monitoring of BCs.
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Affiliation(s)
- Rigo Hoencamp
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
| | - Floris J. Idenburg
- Department of Surgery, Medical Centre Haaglanden, The Hague, The Netherlands
| | | | - Loes G. M. de Kruijff
- Department of Physiatrist, Rehabilitation Center de Hoogstraat, Utrecht, The Netherlands
| | - Eelco P. Huizinga
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands
| | - Marie-Christine J. Plat
- Force Health Protection, Expert Centre Force Health Protection Ministry of Defense, Utrecht, The Netherlands
| | - Erik Hoencamp
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Luke P. H. Leenen
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands
| | - Jaap F. Hamming
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eric Vermetten
- Leiden University Medical Centre, Military Mental Health Research, Utrecht, The Netherlands
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Yehuda R, Vermetten E, McFarlane AC, Lehrner A. PTSD in the military: special considerations for understanding prevalence, pathophysiology and treatment following deployment. Eur J Psychotraumatol 2014; 5:25322. [PMID: 25206950 PMCID: PMC4138707 DOI: 10.3402/ejpt.v5.25322] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 11/29/2022] Open
Abstract
Given the unique context of warzone engagement, which may include chronic threat, multiple and lengthy deployments, and loss, there is a need to understand whether and to what extent knowledge about PTSD derived from studies of civilian trauma exposure is generalizeable to the military. This special issue on PTSD in the military addresses a range of issues and debates related to mental health in military personnel and combat veterans. This article provides an overview of the issues covered in selected contributions that have been assembled for a special volume to consider issues unique to the military. Several leading scholars and military experts have contributed papers regarding: 1) prevalence rates of PTSD and other post-deployment mental health problems in different NATO countries, 2) the search for biomarkers of PTSD and the potential applications of such findings, and 3) prevention and intervention approaches for service members and veterans. The volume includes studies that highlight the divergence in prevalence rates of PTSD and other post-deployment mental health problems across nations and that discuss potential causes and implications. Included studies also provide an overview of research conducted in military or Veteran's Affairs settings, and overarching reviews of military-wide approaches to research, promotion of resilience, and mental health interventions in the Unites States and across NATO and allied ISAF partners.
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Affiliation(s)
- Rachel Yehuda
- James. J. Peters Veterans Affairs Medical Center, New York, NY, USA ; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands ; Arq Psychotrauma Expert Group, Diemen, The Netherlands ; Military Mental Health Research, Department of Defense, Utrecht, The Netherlands
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Lehrner
- James. J. Peters Veterans Affairs Medical Center, New York, NY, USA
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